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NPI Code Detail

MEDICARE: DR. BRANDON KENNY PHILLIP DO

MEDICARE: DR. BRANDON KENNY PHILLIP DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianOS22765FL

General Provider Information

NPI Number : 1902555659
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRANDON KENNY PHILLIP DO
Provider Business Mailing Address
First Line : 203 N MARION ST
Second Line :
City : TAMPA
State : FL
Zip : 33602-4914
Country : US
Telephone Number : 813-474-9804
Fax Number :
Provider Business Practice Location Address
First Line : 203 N MARION ST
Second Line :
City : TAMPA
State : FL
Zip : 33602-4914
Country : US
Telephone Number : 813-474-9804
Fax Number : 813-540-6025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2022
Last Update Date : 02/06/2026

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